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Introduction: The second wave of SAR Cov-2 Infection brought a new menace that was the escalation in the number of mucormycosis, which is a potentially life-threatening, opportunistic, invasive, fungal infection commonly called the "Black fungus". Objective: To find out the factors responsible for occurrence of mucormycosis and the pattern that have emerged in the Post SARS - CoV-19 infected cases admitted in tertiary care hospital of Central India. Material and methods: This descriptive Cross-sectional study was conducted in Government Netaji Subhash Chandra Bose Medical college and hospital of Central India from May 2021 to June 2021. 96 Confirmed cases of mucormycosis were included in this study. The details about Demographical, Epidemiological, clinical data were retrieved by us through interview with patient or his relative and by going through the case sheets of the cases. Results: The mean age for the mucormycosis was among male is 52.68 ±11.13 years and among female it is 47.47±10.07years. 78% of study subjects were hospitalized for treatment while 22% received treatment at home. 72.40% had steroid intake, Mean duration of steroid therapy was 10.15±5.71 days. Mean duration between steroid therapy and appearance of mucormycosis as 14.21±9.1 while mean duration between Covid infection and mucor mycosis was found to be 19.71±9.84 days. Conclusion: Immunosuppression during Covid -19 treatment had catalyst effect on the development of mucormycosis. Early diagnosis and careful monitoring of immuno-compromised individuals is essential. Steroid and other immune- suppressive drugs should be given cautiously. [ABSTRACT FROM AUTHOR]

Background: The term seizure is used to describe abnormal, uncontrolled paroxysmal electrical activity of brain, literature suggests that about 8 -10% of population may experience at least one episode of seizure. Neuroimaging studies like CT scan brain is recommended in adult patients with new onset seizures to determine the underlying cause, structural abnormality, and the possibility of recurrence. Because of its capacity to quickly rule out an intracranial haemorrhage or a tumour requiring immediate neurosurgical intervention, CT scan remains the first -line imaging technology in most acute care settings. Aims and Objectives: To Evaluate the CT scan study in new onset seizure and to identify a lesion in CT scan that can explain the seizure. Materials and methods: Eighty-five patients (age 18 and above) were studied in the outpatient and inpatient department of medicine of a tertiary care centre of central India from 1st July 2019 to 30th June 2021. All patients fulfilling inclusion criteria were subjected to detailed clinical history, examination including neurological examination, and aetiology and characteristics of seizure were co related with CT scan findings. Results: The majority of patients were presented with focal seizures 55 (55%) and with generalised seizures 45(45%). Seizures are more prevalent in age 18 to 40. the prevalence of seizures was higher in males 60% than in females 40%. The abnormal CT scan findings were found in 50.6% cases where seizure were secondary to CVA infarct in 16.5%cases, whereas CVA IP bleed was noted in 10.6% ICSOL was noted in 16.6% cases, with tuberculoma and neurocysticercosis in 5.9% and 4.7% cases respectively. [ABSTRACT FROM AUTHOR]

Background: Appropriate management of ophthalmoplegia demands good anatomy knowledge of cranial nerves involved i.e., III, IV and VI. Where these nerves originate and where they end, clinical features associated with paralysis of each nerve all this knowledge help in proper management of cases. Objective: To study clinical and etiological factors associated with the ophthalmoplegia. Methods: Prospective, Hospital based observational study was carried out among 50 cases of ophthalmoplegia. Detailed history was recorded. Thorough clinical examination including examination of both the eyes was carried out in terms of laterality, pupils affected or not, Central nervous system involvement, cranial nerves III, IV and VI etc. Papilledema, blood pressure, fasting blood sugar were investigated for each case. Results: Most common age group affected was >50 years in 50%. Males were slightly more affected than females. Majority (72%) cases were bilateral. Only nine cases had affected pupils. In ten cases, central nervous system was affected. Hypertension was seen in 32% and diabetes in 44%. 14% had history of trauma. Inflammation, tumor and vascular affection was seen in three cases each. Four cases had viral infection. Among all factors, diabetes was significantly associated with III cranial nerve involvement (p<0.05). Hypertension was significantly associated with IV cranial nerve involvement (p<0.05). But no factor was significantly associated with VI cranial nerve involvement (p>0.05). Conclusion: We conclude that ophthalmoplegia mainly affects elderly and males. It is usually bilateral and sometimes pupils and CNS are affected. Hypertensives and diabetics are at an increased risk of ophthalmoplegia. [ABSTRACT FROM AUTHOR]

Background: Nasolabial cysts are non-odontogenic cysts that arise from the nasal alar area. Sublabial resection of the nasolabial cyst is considered an effective surgical modality of treatment. Objective: This study aimed to evaluate the clinical presentation, diagnosis and treatment of nasolabial cyst at a tertiary care teaching hospital in eastern India. Methods: This was a retrospective study of 38 cases of nasolabial cysts managed between May 2018 and June 2022. The detailed clinical presentations, investigations and treatment of nasolabial cysts of the patients were studied. Results: Out of 38 cases of the nasolabial cyst, 22 (57.9%) were seen on the left side, 13 (34.2%) were seen on the right side and 3 were seen bilaterally. The most common presenting complaint was facial swelling (84.2%). Computed tomography of the nose and paranasal sinuses was done in 24/38 (70.5%) patients studied. Surgical excision of the nasolabial cysts was done by intraoral sublabial approach in 32 (84.2%) cases and 6 underwent endoscopic transnasal marsupialisation. The most common post-operative complication was post-operative facial/perinasal swelling. One case of recurrence was reported who underwent endoscopic transnasal marsupialisation. Conclusions: Nasolabial cysts are an uncommon clinical entity but manifest cosmetic deformity and nasal obstruction. Intraoral sublabial excision and endoscopic transnasal marsupialisation are important surgical techniques for the nasolabial cyst. The post-operative complications and chance of recurrence are rare. [ABSTRACT FROM AUTHOR]

Introduction: Testicular Germ Cell Tumor (GCT) is a disease of young adults and is also highly curable. But in India, most of the patients present in an advanced stage and succumb to the disease as compared to the Western nations where patients present at an earlier stage and are mostly cured. Also, there is a scarcity of literature on testicular GCT from the Indian subcontinent. We present our experience from the Tata Memorial Centre of North-east India. Methods: This retrospective study was conducted at Tata Memorial Centre - BBCI, Guwahati for the period of 5 years from January 2018 to December 2022. The study focused on epidemiology, clinical presentation, and treatment outcomes. Results: Seventy-two cases of testicular GCTs were studied (28 cases were seminoma, and 44 were non-seminoma). Most common presenting stage was stage I in seminoma (53.6%), and stage III (77.2%) in non-seminoma. As per the International Germ Cell Cancer Collaborative Group (IGCCCG) classification, 25%, 35%, and 40% of patients were good-risk, intermediate-risk, and poor-risk in non-seminoma. In patients with seminoma, 54% and 46% were in good and intermediate-risk, respectively. Seventy-two percent and 21% had achieved a radiologic complete response (CR) and partial response (PR) with conventional chemotherapy in patients with seminoma. Radiologic CR and PR rates were 20% and 61% among non-seminoma patients. The median recurrence-free survival (RFS) was 43 months. RFS was better in seminoma versus non-seminoma, stage I versus stage III, and good-risk versus high-risk group. Conclusion: Most of our patients presented with an advanced stage of the disease and a high nodal burden. In patients with non-seminoma GCT, the best response to conventional chemotherapy was a partial response. The use of an alternative chemotherapy regimen to improve outcomes for such patients can be further explored. [ABSTRACT FROM AUTHOR]

Background: It has been proposed that, thrombocytopenia is the most common haematological abnormality in pregnancy after anaemia. The incidence of severe immune thrombocytopenia (ITP) in pregnancy has been difficult to report because of the rarity of the disease. Aims and objectives: Objectives were to determine the prevalence, pregnancy outcomes, treatment modalities of ITP mothers in a tertiary health care hospital in West Bengal, India. Methods: Our study was a retrospective record study. Records of the in-patient medical record department (MRD) folders of patients with ITP who delivered at Dept of G&O, N.R.S. Medical College and Hospital, Kolkata, West Bengal, India from November 2018 to November 2022. Statistical data were analysed by using SPSS V.20 software. Results: Most common age group of the mother found to 19-25 years 10 (43.5%). Gravida 1 was 11 (47.8%), followed by gravida 2 was 8 (34.83%). IUFD was 1 (4.3%), preterm was 7 (30.4%), SA was 2 (8.7%), term was 12 (52.2%) and neonatal death was 2 (8.7%). Associated Haematological Disorder of B Thal Trait and HbE Carrier was 3 (10.3%) each. Platelet Count during AN Period as <49000 was 13 (56.5%) and 50000-99,999 was 10 (43.5%). Myasthenia gravis during pregnancy was 7 (30.4%), Methylprednisolone was 3 (13.0%), thyroid disorder was among 5 (21.7%). Conclusion: Chronic ITP in pregnancy poses more risks to mother and foetus as seen with the higher chance of PPH etc. Mothers with ITP should be screened antenatally as the chances of anomalies are high in foetus. [ABSTRACT FROM AUTHOR]

Background and Objectives: Chronic rhinosinusitis (CRS), a prevalent ENT condition, often presents treatment-resistant cases. Gastroesophageal Reflux Disease (GERD) causing Laryngopharyngeal reflux (LPR) is implicated in its etiology. This study aims to assess LPR prevalence in refractory CRS and the impact of combining proton pump inhibitors (PPIs) with functional endoscopic sinus surgery (FESS). Methods: 50 refractory CRS patients were evaluated, split into study (PPIs + FESS) and control (FESS only) groups in the Department of ENT at a tertiary care medical college in India. CRS indicators were assessed, and post-surgery, study patients received intranasal steroids and PPIs. A 3-month follow-up tracked symptom relief. Result: Majority of refractory CRS patients had LPR, mainly affecting the posterior larynx. Nasal obstruction, discharge, and polyps were common CRS indicators. Study group with PPIs showed greater improvement in symptoms, notably by the third postoperative month. Conclusion: The study highlights a significant link between refractory CRS and GERD. PPIs, when used alongside FESS, offer effective refractory CRS management, emphasizing combined treatment's advantages. [ABSTRACT FROM AUTHOR]

Background: Schwannomas are neoplasms that are rarely found in the sinonasal tract and pterygopalatine fossa (PPF). The objective of this study is to evaluate the schwannoma in the sinonasal tract and PPF including its effectiveness of endoscopic surgical excision of the lesion. Methods: This retrospective study was done between March 2018 and April 2022. There were nine cases of benign schwannomas found in the nasal cavity, the nasal ethmoid and the PPF. All patients had undergone endoscopic endonasal removal of the tumour. Results: All the patients successfully underwent endonasal endoscopic excision of the schwannoma from the sinonasal tract and PPF. Out of nine patients, one showed recurrence after 1 year during follow-up check-ups. None of the patients showed any major vascular complications during surgery. At follow-up, one patient presented with a persistent sensory deficit in the facial area. Conclusions: The endonasal endoscopic approach for schwannoma at the sinonasal tract and PPF is a safe and effective method for biopsy and treatment. This approach is highly effective for visualisation and has the potential to reduce complications. Pre-operative imaging is an important step before successful treatment by endoscopic endonasal removal of the schwannoma. [ABSTRACT FROM AUTHOR]

Infections caused by multi-drug resistant Klebsiella pneumoniae are a leading cause of mortality and morbidity among hospitalized patients. In neonatal intensive care units (NICU), blood stream infections by K. pneumoniae are one of the most common nosocomial infections leading to poor clinical outcomes and prolonged hospital stays. Here, we describe an outbreak of multi-drug resistant K. pneumoniae among neonates admitted at the NICU of a large tertiary care hospital in India. The outbreak involved 5 out of 7 neonates admitted in the NICU. The antibiotic sensitivity profiles revealed that all K. pneumoniae isolates were multi-drug resistant including carbapenems and colistin. The isolates belonged to three different sequence types namely, ST-11, ST-16 and ST-101. The isolates harboured carbapenemase genes, mainly blaNDM-1, blaNDM-5 and blaOXA-232 besides extended-spectrum b-lactamases however the colistin resistance gene mcr-1, mcr-2 and mcr-3 could not be detected. Extensive environmental screening of the ward and healthcare personnel led to the isolation of K. pneumoniae ST101 from filtered incubator water, harboring blaNDM-5, blaOXA-232 and ESBL genes (blaCTX-M) but was negative for the mcr genes. Strict infection control measures were applied and the outbreak was contained. This study emphasizes that early detection of such high-risk clones of multi-drug resistant isolates, surveillance and proper infection control practices are crucial to prevent outbreaks and further spread into the community. [ABSTRACT FROM AUTHOR]

Background: Cerebrospinal infections are the cause of poor prognosis among post-neurosurgery patients owing to delay in improvement of neurological functions, leading to increased length of hospital stay, proceeding to disability or death. Methods and materials: This retrospective observational study was performed at a tertiary care center in Northern India, where all patients with bacterial cerebrospinal infections from July 2019 to July 2022 were evaluated for post-neurosurgery cerebrospinal shunt infections, and all demographic data and risk factors were extracted from the hospital information system (HIS). Results: The study includes 150 (150/1986, 7.55%) culture-confirmed cases of bacterial meningitis out of 1986 cases of suspected bacterial meningitis patients. Ninety-six (96/150, 64.0%) post-neurosurgery patients with cerebrospinal fluid (CSF) leaks were managed using external ventricular drain (EVD) or ventriculo-peritoneal (VP) shunt. Seventy-four (74/96, 77.08%) patients were managed only on EVD, whereas 22 (22/96, 22.92%) patients were managed only on VP shunt. Eighty-two (82/96, 85.4%) multidrug-resistant microorganisms (MDROs)were isolated and 70 (70/82, 85.36%) were Gram-negative bacteria, of which 56 (56/74, 75.68%) Gram-negative bacteria showed extended-spectrum betalactamase (ESBL)-producing character in those with an EVD, 14 (14/22, 63.63%) with a VP shunt. Among Gram-negative bacteria, Acinetobacter baumannii showed high rates of resistance: 21 (21/23, 91.30%) and 8 (8/8, 100%) were ESBL-producing A. baumannii in patients managed on EVD and VP shunt, respectively. Conclusion: This study determines the risk factors, the spectrum of pathogenic microorganisms, multidrug resistance, and the nature of intracranial lesions isolated among the patients who developed bacterial cerebrospinal infections in post-neurosurgery patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: Mucormycosis is a rare but serious fungal infection which has dramatically increased in post-COVID patients. There is a paucity of safety data on amphotericin B (amphoB) used for mucormycosis treatment. OBJECTIVES: The objective of this prospective, observational, active safety surveillance study was to evaluate the safety profile of amphoB in a cohort of hospitalized patients who were on the drug for suspected mucormycosis. MATERIALS AND METHODS: All suspected adverse drug reactions (ADRs) in hospitalized mucormycosis patients who had received amphoB were analyzed. The nature, severity, outcome of the ADRs were recorded and analyzed. RESULTS: Of the 77 patients enrolled, 70% had documented history of prior COVID-19 infection. 96% had comorbidities, the most common being diabetes. Majority received conventional amphotericin B deoxycholate formulation. 97% experienced at least one suspected ADR and the median ADR/patient was 3. Out of 214 ADRs, 91 were serious but there were no ADR-related deaths. The most common ADRs were hypokalemia (31.78%), infusion-related reactions (22.43%), and anemia (17.29%). Thirty-three patients had serum potassium <2.5 mEq/L, while 11 had serum magnesium <1.25 mg/dL. Doubling of pretreatment creatinine level was noted in 15 patients. Seventy percent ADRs were of "possible" category as per the World Health Organization Uppsala Monitoring Centre categorization. CONCLUSION: AmphoB deoxycholate use in mucormycosis patients was associated with a high incidence of electrolyte abnormalities and infusion-related reactions. All ADRs subsided with medical management and none were fatal. The safety data generated from this study may be useful in resource-limited settings where the far more expensive liposomal formulation is not being used. [ABSTRACT FROM AUTHOR]

Background: Quality management in healthcare is critical for hospitals and everyone in the loop —from physicians to support staff—needs to be aware of and involved in this process. Objectives: To assess the perception of employees about the quality management system (QMS) implemented at a tertiary care eye hospital in north India and to use it to identify scope for further improvement. Methods: This cross-sectional mixed-method study involved both questionnaire-based survey and an in-depth interview by a third party. The questionnaire had 12 questions to assess the changes in culture, infrastructure, environment, system, operation theatre and outpatient department. Employees shared their opinion about improvements brought by the QMS in eight years. Respondents were divided into five groups based on their job description: (i) doctors, (ii) technical staff (nursing/operation theatre/laboratory), (iii) optometrists/opticians/audiologists, (iv) patient care executives and (v) human resources/administration/others. Results: Of the 73 employees interviewed, 94.5% perceived an improved treatment and care process and 91.8% perceived improved treatment results. According to 83.6% of the employees, they were encouraged to report patient safety concerns and 71.2% saw improved incidence and adverse event management. The QMS has increased patient satisfaction according to 83%, while 91.8% felt it improved the profile of the hospital. The employees stated no negative effects of the QMS except a long waiting time of the patients and the duplication of paperwork. Conclusion: QMS has brought many positive changes across the hospital. Still, there is scope to reduce the patient waiting time and paperwork duplication. [ABSTRACT FROM AUTHOR]

Background: The term seizure is used to describe abnormal, uncontrolled paroxysmal electrical activity of brain, literature suggests that about 8 -10% of population may experience at least one episode of seizure. In adult patients with new onset seizures, neuroimaging studies like MRI brain are advised to find out the underlying cause, structural abnormality, and the likelihood of recurrence. For neuroimaging, CT scan and MRI both can be done but for detection of cerebral lesions, imaging with MRI is considered superior to CT scan. MRI becomes essential, because of its superior depiction of brain anatomy and tissue composition. Aims and Objectives: To Evaluate the MRI brain study in new onset seizure and to identify a lesion in MRI brain that can explain the seizure. Materials and methods: sixty-nine patients (age 18 and above with new onset seizures) were studied in the out-patient and in-patient department of medicine of a tertiary care centre of central India from 1st July 2019 to 30th June 2021. All patients fulfilling inclusion criteria were subjected to detailed clinical history, examination including neurological examination, and etiology and characteristics of seizure were co related with MRI brain findings. Results: The majority of patients were presented with focal seizures 38(55%)and with generalized seizure 31(45%). Seizures are more prevalent in age 18 to 40 years. The prevalence of seizures was higher in males (60%) than in females (40%). MRI brain revealed abnormal findings on 68.1% cases with new onset seizures. MRI revealed CVA in 17.3% cases (infarct in 13% and bleed in 4.3%), tuberculoma in 7.2% and neurocysticercosis in 5.8% cases, viral and tubercular meningitis in 4.3% cases each, Cortical Venous Thrombosis was noted in 8.7% cases, AV Malformations, Mesial temporal lobe sclerosis, Posterior reversible encephalopathy syndrome (PRES) and Dyke Davidoff Masson Syndrome were noted in 2.9% cases each. [ABSTRACT FROM AUTHOR]

This study aimed to determine the patient demographics, risk factors, which include comorbidities, medications used to treat COVID-19, and presenting symptoms and signs, and the management outcome of COVID-19-associated invasive fungal sinusitis. A retrospective, propensity score-matched, comparative study was conducted at a tertiary care center, involving 124 patients with invasive fungal sinusitis admitted between April 2021 and September 2021, suffering from or having a history of COVID-19 infection. Among the 124 patients, 87 were male, and 37 were female. A total of 72.6% of patients received steroids, while 73.4% received antibiotics, and 55.6% received oxygen during COVID-19 management. The most common comorbidities were diabetes mellitus (83.9%) and hypertension (30.6%). A total of 92.2% had mucor, 16.9% had aspergillus, 12.9% had both, and one patient had hyalohyphomycosis on fungal smear and culture. The comparative study showed the significant role of serum ferritin, glycemic control, steroid use, and duration in COVID-19-associated invasive fungal disease (p < 0.001). Headache and facial pain (68, 54.8%) were the most common symptoms. The most involved sinonasal site was the maxillary sinus (90, 72.6%). The overall survival rate at the three-month follow-up was 79.9%. COVID-19-related aggressive inflammatory response, uncontrolled glycemic level, and rampant use of steroids are the most important predisposing factors in developing COVID-19-associated invasive fungal sinusitis. [ABSTRACT FROM AUTHOR]

Rotavirus is a major cause of severe acute gastroenteritis in infants and young children worldwide. It is responsible for 40% of childhood hospitalization. It has been estimated that about 23% of diarrhoeal death occurs due to the rotavirus infection in India. To study the epidemiology of rotavirus infection in children less than 5 years of age at a tertiary care teaching hospital. A total of 240 stool samples were collected from children <5 years of age suffering from acute diarrhea at a tertiary health care referral hospital in Western Uttar Pradesh, India. Rotavirus antigen was detected in stool by Enzyme immunoassay (EIA) which utilizes monoclonal antibodies directed against VP6 antigen. Molecular genotyping was done by nested multiplex PCR. The rotavirus antigen positivity rate was found to be 14.58% in this study. There was male preponderance and the male: female ratio was 1.5:1. Rotavirus diarrhoea was reported predominantly (42.85 %) in the age group of 13 to 24 months. The most common circulating G/P genotype strain was G9P[4] accounting for 36% of cases. Rotavirus remains a major cause of diarrhoea in children <5 years of age in Uttar Pradesh. However, the positivity rate has decreased after introduction of rotavirus vaccine into the Universal immunization program (UIP) in UP. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the demographics, etiology, complications, treatment modalities, and visual outcomes in pediatric uveitis patients at a tertiary eye care hospital. Methods: A retrospective review of medical records of pediatric uveitis patients who presented with us from January 2014 to January 2020 was evaluated. Results: Out of the 178 pediatric uveitis patients, 65 children were included in the study. The most common age group was 6–10 years (46%). Of the included patients, 36 (55.4%) were male and 29 (44.6%) were female. Presentation was bilateral in 39 (60%) and unilateral in 26 (40%). Anterior uveitis was seen in 19 (29.23%), intermediate in 18 (27.69%), posterior in 16 (24.62%), and panuveitis in 12 (18.46%) patients. There were 2 cases of masquerades. Non-infectious uveitis was the most commonly seen, in 48 (73.84%) of total cases, among which 21 (43.75%) were idiopathic and 7 (14.58%) were associated with juvenile idiopathic (JIA) arthritis. Infectious uveitis was present in 17 (26.15%); the most common etiology was toxoplasmosis. Baseline visual acuity was low in 22 (33.84%) children. After initiating treatment, 37 (56.92%) showed improvement in vision and 10 (15.38%) had worsening of vision. Intraocular pressure (IOP) rise was seen in 5 (7.69%) children; 51 (78.46%) children required medical management and 16 (24.61%) children required surgical intervention; 46 (70.76%) children had uveitis related complications out of which most of them 30 (65.21%) were present at baseline. Conclusions: Anterior and intermediate uveitis were the most common types observed in our study. Toxoplasmosis was the most common type of infectious uveitis and JIA the most common cause in non-infectious type apart from idiopathic uveitis. Posterior uveitis had low visual acuity at baseline and follow-up. Children presented to us with poor visual acuity and complications at baseline, hence an early referral to a tertiary eye hospital and management accordingly can improve the quality of vision and visual rehabilitation. [ABSTRACT FROM AUTHOR]

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Introduction: COVID-19 pandemic has been a curse for cancer patients. The lack of understanding and unawareness in handling cancer patients during this pandemic has worsened their conditions. To analyze the real-world scenario, we studied 13 patients who were given immunotherapy during this COVID pandemic era and tried to analyze their outcome or any serious adverse effect that they suffered. This was a pilot study which would pave the way for further bigger studies in future. The aim of the study was to collect the details of patient receiving immunotherapy during COVID-19 pandemic. The data collected included the diagnosis, certain investigations, and the effects of the immunotherapy drugs and its side effects. Results: During this COVID pandemic period starting from March 20 to June 20, we have been regularly giving immunotherapy drugs such as nivolumab, pembrolizumab, and atezolizumab to our patients. We had given six patients nivolumab, six patients pembrolizumab, and one patient atezolizumab. Of the 13 patients who continued to receive immunotherapy in COVID pandemic era, 4 patients were receiving immunotherapy for lung cancer, 3 for head-and-neck malignancy, 2 for relapse lymphoma, and 1 each for hepatocellular carcinoma, renal cell cancer, malignant melanoma, and soft-tissue cancer. One of the patients receiving atezolizumab had actually progressed after receiving pembrolizumab. There was no Grade 3 or 4 toxicity to these drugs and most of our patients continued to be in stable disease/partial remission. One patient had died just after receiving one cycle of nivolumab. Conclusion: COVID-19 infection has posed an unforeseen predicament both for the patients and the treating oncologist. In absence of any previous data, it is very difficult to manage cancer patients where the treatment itself is thought to harm the patients. This is a humble effort to bring to the notice of the world that immunotherapy can be continued during COVID pandemic, provided we take all due precautions. [ABSTRACT FROM AUTHOR]

Background: In 2016, there was a massive outbreak of chikungunya in North India. During the epidemic, we observed many neonatal and early infantile cases of chikungunya, with a probable perinatal transmission.Methods: This retrospective study was carried out in a tertiary care neonatal centre between August 2016 and November 2016. Chikungunya virus (CHIKV) infection was detected and confirmed by reverse transcription-polymerase chain reaction (RT-PCR) and/or serology (anti-CHIKV IgM) in mothers and infants. Clinical features and laboratory parameters were recorded.Results: There were 16 cases of confirmed CHIKV infections during the study period. For babies presenting during the neonatal period (n = 13), the median age of presentation was 9.5 (range: 3-15) days, whereas for babies (three) presenting after the neonatal period, the median age was between 1 and 3 months. The most common presentation was fever (69%), followed by lethargy (56%) and seizures (50%). Skin manifestations were observed in 25% of the cases, which included maculopapular rashes, bullous lesions and hyperpigmentation over the axilla, perioral and genital areas. None of the cases had any feature of arthritis. Of all the cases included in the study (n = 16), RT-PCR for CHIKV was positive in 14 (87.5%), whereas the serum anti-CHIKV IgM antibody test was positive in two (12.5%) cases. Six (37.5%) cases were documented as perinatal CHIKV, as RT-PCR for CHIKV was positive in both mothers and babies. Fifteen babies survived and were discharged in a stable condition with no oxygen requirement and on full feeds. One baby died because of multi-organ failure and catecholamine refractory hypotension.Conclusion: In endemic areas, paediatricians should have a low threshold of suspicion for perinatal or neonatal chikungunya in any infant presenting with signs and symptoms mimicking sepsis, especially with skin manifestations, seizure and/or encephalopathy. [ABSTRACT FROM AUTHOR]

Purpose: Ocular trauma constitutes an important cause of preventable visual morbidity worldwide. This study was done to study the incidence, sociodemographic pattern, and clinical profile of ocular trauma in pediatric age group. Also to evaluate the factors influencing final visual outcome in these patients.Methods: This was a prospective interventional study concerning ocular trauma in pediatric patients up to 16 years of age of either sex. Various variables having an impact on final visual outcome were studied, and results were analyzed using statistical indices - relative risk, Chi-square test, P value, and linear regression analysis.Results: A total of 220 cases of trauma were evaluated with the mean age being 8.74 ± 3.93 years, males were predominantly affected and open globe injuries outnumbered blunt injuries. Penetrating injuries accounted for 67.79% cases of open globe injury, rupture being the least (2.54%). Stepwise multiple linear regression analysis executed, showed the best predictors in the descending order for final visual outcome were presenting visual acuity, size of corneal tear, type of injury, zone of injury, time period between injury and treatment with a variance of 35.9%, 6.3%, 5.3%, 3.7%, and 2.7%, respectively. All above variables were also found to be statistically significant (P < 0.05) on Chi-square test.Conclusion: We report the first study on the epidemiology and clinical outcomes of pediatric ocular trauma in central India. Poor initial Visual Acuity and posterior segment involvement adversely affect the visual outcome. Early medical treatment and globe-salvaging repair should be done in all eyes suffering from trauma. [ABSTRACT FROM AUTHOR]

Background & objectives: Congenital adrenal hyperplasia (CAH) is an autosomal recessive disorder with a wide range of clinical manifestations. The disease is attributed to mutations in CYP21A2 gene encoding 21-hydroxylase enzyme. In view of severe phenotype in salt-losing cases, issues related to genital ambiguity in girls and precocity in boys, most families opt for prenatal testing and termination of affected foetus. CAH can be diagnosed in utero through direct molecular analysis of CYP21A2 gene, using DNA extracted from foetal tissues or cells obtained from chorionic villus sampling or amniocentesis. The objective of this study was to evaluate the feasibility and accuracy of prenatal diagnosis (PND) using sequencing and multiplex ligation probe amplification (MLPA) methods in families at risk for CAH. Methods: Fifteen pregnant women at risk of having an affected offspring with CAH were included in this study. Ten families had previous affected children with salt-wasting/simple virilising form of CAH and five families did not have live children but had a high index of suspicion for CAH in previous children based on history or records. Mutation analysis was carried out by Sanger sequencing and MLPA method. Results: Seven different mutations were identified in 15 families. Deletions and I2g mutation were the most common. Of the 15 foetuses analyzed, nine were unaffected while six were affected. Unaffected foetuses were delivered, they were clinically normal and their genotype was found to be concordant to the prenatal report. All except two families reported in the second trimester. None of the couples opted for prenatal treatment. Interpretation & conclusions: Our preliminary findings show that PND by direct mutation analysis along with MLPA is a feasible strategy that can be offered to families at risk. [ABSTRACT FROM AUTHOR]